Lessons Learned, Promising Practices and Opportunities for Addressing Social Needs of Medicaid Beneficiaries: Perspectives of Medicaid Managed Care Organizations

Document Type

Presentation

Presentation Date

6-14-2021

Abstract or Description

Research Objective:

There is a growing focus on social determinants of health among Medicaid Managed Care Organizations (MMCOs), driven by an increased recognition of its impact on member health and growing states’ interest on the subject matter. The purpose of this qualitative study was to describe lessons learned, promising practices and opportunities for addressing social needs of Medicaid beneficiaries from the perspective of MMCOs.

Study Design:

Twenty-six interviews were conducted with representatives of MMCOs. Each interview lasted an hour, on average and was audio-recorded and transcribed. Transcripts were then analyzed by two researchers, following Braun and Clarke’s (2006) approach for thematic analysis.

Population Studied:

Representatives of eight national and regional MMCOs operating in nine states. Participants included MMCO senior executives, medical directors, directors of case management, and directors and staff of dedicated programs to address social needs of members.

Principal Findings:

Participants reflected on their organization’s efforts to address the social needs of Medicaid beneficiaries and shared lessons learned – including the importance of partnerships and relationship building, community-centeredness, flexibility, and agility – in effectively addressing member social needs.

Promising practices for addressing social needs of Medicaid beneficiaries included (a) the dedication of organizational resources to specifically address member social needs, (b) intentional member engagement, (c) the adoption of a community-centric and data driven approach for addressing social needs, and (d) the adoption of a continuous improvement mindset that leveraged employees as hubs of innovation.

Participants also discussed opportunities for evolving current efforts to address the social needs of Medicaid beneficiaries. Opportunities included the need for: (a) reimbursement policy reform to reflect the importance of “whole-person” care; (b) formal integration of social services organizations into the healthcare delivery system; (c) streamlined health information ecosystems to include data exchange among stakeholders across the medical, behavioral and social continuum of care; (d) expanded use of data and analytics to deliver quality and responsive holistic care; and (e ) inter-disciplinary and cross-sector collaboration to effectively address member social needs.

Conclusions:

MMCOs’ success in addressing the social needs of Medicaid beneficiaries may be achieved through adaptive, grassroot, member and community-centric efforts, facilitated by system-level changes that normalize attention to social needs within the healthcare paradigm.

Implications for Policy or Practice:

The findings from this study suggest the need for delivery system innovation to better align healthcare financing with the increasing focus on “whole-person” care, and to facilitate the creation of a holistic community-centered healthcare ecosystem that fully engages social service organizations in health care delivery.

Reference: Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

Additional Information

Georgia Southern University faculty members, Bettye Apenteng, Samuel Opoku, Charles Owens, Linda Kimsey, Angela Peden, William Mase co-presented Lessons Learned, Promising Practices and Opportunities for Addressing Social Needs of Medicaid Beneficiaries: Perspectives of Medicaid Managed Care Organizations in the Academy Health Annual Meeting, June 2021.

Sponsorship/Conference/Institution

Academy Health Annual Meeting

Location

Virtual

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